Violence in the emergency department: a survey of health care workers

Background: Violence in the workplace is an ill-defined and underreported c oncern for health care workers. The objectives of this study were to examin e perceived levels of violence in the emergency department, to obtain healt h care workers' definitions of violence, to determine the effect of violenc e on health care workers and to determine coping mechanisms and potential p reventive strategies. Methods: A retrospective written survey of all 163 emergency department emp loyees working in 1996 at an urban inner-city tertiary care centre in Vanco uver. The survey elicited demographic information, personal definition of v iolence, severity of violence, degree of stress as a result of violence and estimate of the number of encounters with violence in the workplace in 199 6. The authors examined the effects of violence on job performance and job satisfaction, and reviewed coping and potential preventive strategies. Results: Of the 163 staff, 106 (65%) completed the survey. A total of 68% ( 70/103) reported an increased frequency of violence over time, and 60% (64/ 106) reported an increased severity. Most of the respondents felt that viol ence included witnessing verbal abuse (76%) and witnessing physical threats or assaults (86%). Sixty respondents (57%) were physically assaulted in 19 96. Overall, 51 respondents (48%) reported impaired job performance for the rest of the shift or the rest of the week after an incident of violence. S eventy-seven respondents (73%) were afraid of patients as a result of viole nce, almost half (49%) hid their identities from patients, and 78 (74%) had reduced job satisfaction. Over one-fourth of the respondents (27/101) took days off because of violence. Of the 18 respondents no longer working in t he emergency department, 12 (67%) reported that they had left the job at le ast partly owing to violence. Twenty-four-hour security and a workshop on v iolence prevention strategies were felt to be the most useful potential int erventions. Physical exercise, sleep and the company of family and friends were the most frequent coping strategies. Interpretation: Violence in the emergency department is frequent and has a substantial effect on staff well-being and job satisfaction.